Category: CO Dept. Of Health Care Policy & Financing

SEPT 4 MEETING WITH HCPF: LAW, POLICY & DISCRETION

9/8/2019

Federal Law

Colorado has historically taken a pretty laissez faire attitude towards compliance with Federal Disability Civil Rights Laws: They're not necessarily against -- but if it starts getting inconvenient --- they'll skip it.

Further, that is not just Colorado -- that is most States.

So other long-time Mental Health Advocates and I were NOT SHOCKED to find that HCPF [Colorado's Department of Health Care Policy & Financing] seemed to view compliance with FAIR HOUSING as a discretionary matter.

We brought up FAIR HOUSING issues relating to HCPF and its providers this SUMMER --- NOTHING HAS BEEN DONE ON THAT. IT SHOULD HAVE BEEN RESOLVED THIS SUMMER.

Well, we had this meeting didn't we? Most advocates have had their time wasted by State meetings for years -- and in the case of Mental Health Pioneer Amy Smith -- 2 decades.

A meeting is not action -- FURTHER -- State Officials very rarely engage in an in-depth discussion of TIMELY SOLUTIONS TO VIOLATIONS OF FEDERAL CIVIL RIGHTS LAW -- they just try to keep you talking and hope you don't realize they are stringing you along.

WE NEED HCPF to PUT FAIR HOUSING COMPLIANCE as that relates to CASE MANAGERS & PROVIDERS and themselves as the GIVER of REASONABLE ACCOMMODATIONS on a FAST TRACK.

THIS IS NOT DISCRETIONARY. Denver Metro Fair Housing and or Civil Rights Education and Enforcement Center could provide Education as could the Division of Housing in the CO Dept. of Local Affairs.

If necessary we will seek outside litigators to investigate and pursue this matter further.

"Policy" Issues

So here the State does have a lot of discretion.

By Amy Sherald

We want to clarify that the specifics we want to engage in are STATE ACTIONS NEEDED for COMPLIANCE WITH THE LAW.

Most advocates don't have the resources to be terribly unrealistic and are more than willing to go along with "Reasonable Compliance Plans."

Maybe you really can't get low level resolution of systemic violations of Federal Disability Civil Rights Law @ the Executive Agency Level.

THE NEED FOR FEDERAL LEADERSHIP TO ADDRESS UNCERTIFIED "GRAVELY DISABLED" -- THE ANSWER IS NOT CERTIFICATION

7/29/2019

So all of this has a great deal to do with:

folks with cognitive disabilities that have mental illness
brain injury
substance issues, and
developmental disabilities

AND

are homeless or @ great risk of homelessness
involved with CHILD WELFARE
involved with and or @ great risk of involvement with the Criminal Justice System

WestWord did a story recently on how "insanity" isn't just a plea for murderers anymore. The ax murderer or Aurora Theater shooter is who we often think of as the person with mental illness in the Criminal Justice System.

There are thousands of people with MI & Brain Injury & Substance Issues in the Criminal Justice System while Incompetent to Proceed and Insanity are strictly construed.

CO Medicaid Providers & the CO Dept. of Health Care Policy and Financing have no idea how @ risk these folks are, even as Medicaid's own providers are pursuing harassment charges.

Further, most Medicaid folks are not familiar with the TONE of JUDGES towards people with disabilities, MOST IMPORTANTLY in the JUDGE's SENTENCING.

All those THOUSANDS of people with cognitive disabilities didn't go to prison by accident. AND every little prior builds on itself.

We've got to get really honest about what it takes to keep people with cognitive disabilities out of the Criminal Justice System.

So the conservative Treatment Advocacy Center as well as the Mental Illness Policy Organization have been big proponents of certification and assisted outpatient certification -- which Colorado has.
Further, Colorado state officials have in the past backed amendments to Colorado's certification statutes broadening the definition of "gravely disabled." This has been supported by a number of Colorado organizations including Mental Health Colorado and NAMI Colorado.
Similar actions have been taken in other states.

Certification statutes are State Statutes.

On the other hand, the following are Federal Statutes:

The Medicaid Act, including Medicaid Network Adequacy
Section 504 of the Rehabilitation Act [reasonable accommodations]
The Americans with Disabilities Act [including Olmstead and "reasonable accommodations of policy, practice & procedure"]
The Federal Fair Housing Act [reasonable accommodations]
Mental Health Parity & Addiction Equity Act of 2008

Further, broad concepts such as "reasonable accommodations" and "parity" require an enormous amount of guidance.

We favor highly detailed but flexible Federal data-driven templates for States to comply with, and state ability to request data-driven modifications of such detailed templates if not contrary to law .

It is a lot easier to work off something -- than to create it out of whole-cloth.

A HUGE, COMPLICATED issue is FAIR HOUSING as it relates to Medicaid State Agencies, Medicaid Providers and people with cognitive disabilities.

Colorado & Most States are NOT complying with:

Olmstead (1999) -- most States are very aware of Olmstead, or
The Federal Fair Housing Act (1968); Amendments (1988)

[CO's Dept. of Health Care Policy & Financing is NOT familiar with the Federal Fair Housing Act even though it directly impacts their agency, placement providers, case managers and consumers -- Further, a lot of this does relate to the INFORMATION OVERLOAD that is stressing the entire society.]

So there are a lot of things going on with regard to these issues. Resources being a HUGE issue.

Nobody knows better than we do that accommodations can take resources, especially in light of the fact we recently had a situation figuratively "blow up" on us when we didn't have the resources to make the accommodations needed for an individual.

There are a lot of practical aspects to this that need to be worked through -- Technical Assistance Centers could really help with that. We don't need to re-invent the wheel in 50 States -- but we do need to give States the opportunity to make data-driven modifications if not contrary to the law.

Gravely Disabled

Ethics & The Current System

7/27/2019

When we think about problems with the Mental Health System 2 Common issues that come up are:

Civil Commitment Statutes, and
HIPAA

Neither of these issues really gets to the root cause of most problems.

If there are sufficient:

housing
placements,
services, and
reasonable accommodations --

The rest is largely moot. When there aren't -- providers, family members and attorneys have a lot of hard choices to make.

We've learned the hard way how difficult it is to make the decision to file a petition for court-ordered evaluation even when the grounds may exist -- time, resources, unnecessary further upset, etc.

We've talked some on this page about what the goal is -- and not mistaking the "means" as the end. The goal is NOT certification.

The goal is adequate placements and services and avoidance of homelessness and criminal justice involvement.

That is not cut and dry. AND most importantly, are we going to do more harm than good?

That is the difficult problem many providers, family members and attorneys are faced with.

So the ultimate answer is not Civil Commitment Statutes that providers, family members and even attorneys may feel could make the situation worse.

But providers, family members, attorneys and the communities need VIABLE alternatives. Right now we don't have too many alternatives. That is why so many people rotate in and out of the Criminal Justice System despite being on Medicaid and often dumped by their providers.

HCPF [Colorado's Dept. of Health Care Policy & Financing] has not sufficiently addressed this.

Trying to reform Colorado's crappy mental health System---The first step is recognizing the problem(s)

9/16/2018

It was really Mental Health America's report ranking Colorado 48th in Child Mental Health Care that is in large measure spurring the current reform efforts in State Government.
Data is really critical for reform in modern society, anecdotal reports are often not enough and individuals and advocates often don't have access to the information that is needed -- and sometimes that's because the State isn't collecting it.
We were really pleased to see some of the questions on OBH's Roadmap to Reform Children's Mental Health.
While people can certainly play with the numbers, our experience is that fair-minded data collection CALMS THINGS DOWN A LOT.
Then one can really get down to creative problem solving and there are generally pretty complicated reasons for problems.
Being able to agree that:

There is a problem, and
We need to solve it

really saves enormous time and energy right there.
It looks like that is happening in Children's Mental Health with a collaborative approach among OBH, HCPF [CO Dept. of Health Care Policy & Financing] and stakeholders.
The same needs to happen in Adult Mental Health. That's where we think a Tiered System could transform our dangerously inadequate system of intensive mental health services.

“The State of Mental Health in America” report. 

OBH's Questionnaire on the Roadmap to Reform Children’s Mental Health -- Deadline Sept. 19, 2018

https://mailchi.mp/state.co.us/provide-feedback-on-the-roadmap-to-reform-childrens-mental-health?e=cfc778e7cc

The Colorado Health Institute is another option for State Government and Stakeholders when it comes to non-partisan data collection and analysis.
https://www.coloradohealthinstitute.org/research/behavioral-health-colorado

COACT Colorado & High Fidelity wraparound services could serve as a Model for Medicaid Adult Mental Health Services

5/12/2018

We have a HUGE challenge: bringing Medicaid Intensive Mental Health Services to scale to meet the need.

CO Medicaid to our knowledge still has not changed their regulations regarding Assertive Community Treatment (ACT), Residential Services, and Intensive Case Management as Alternative Services -- not available to all where reasonably medically necessary.

We were told by HCPF that ACT would be available where reasonably medically necessary -- but it seems to still be listed as an "Alternative Service."

That "Alternative Service" designation doesn't pass Mental Health Parity Muster as far as we're concerned.

But an option available to the State is to create an array of INTENSIVE SERVICES such as High Fidelity Wraparound to reduce the need for Residential Services and ACT.

Also, I think HIGH FIDELITY WRAPAROUND is better than Intensive Case Management --because it doesn't burnout the caseworkers as quickly and the results are likely better.

The Colorado Department of Human Services (CDHS) is already using HIGH FIDELITY WRAPAROUND for youth with serious behavioral issues -- under COACT, albeit not statewide.

COACT looks like Youth Assertive Community Treatment (ACT) with some built-in protective concepts such as:

Family Voice & Choice
Use of Natural Supports
Community-based
Culturally Competent
Individualized
Strength-Based
Persistence
Outcome-Based

Words matter -- the focus on High Fidelity Wraparound as opposed to "Assertive Community Treatment" probably has a lot of advantages -- it doesn't sound coercive and it seems more description.

I think this is pretty much what the people in the Adult Arena want as well when it comes to Assertive Community Treatment--High Fidelity Wraparound with Individual Voice and Choice.

Now one of the things that characterizes ACT is 24/7 -- 7 days a week coverage. Now not everybody probably needs that -- BUT a whole lot of people need HIGH FIDELITY WRAPAROUND.

With graduated intensive services available where reasonably medically necessary and clear screening tools, our Medicaid Intensive Mental Health Services could become much more understandable and user-friendly for everyone.

Under Medicaid Network Adequacy, we need to have an understanding of how many Coloradans need to access various levels of intensive mental health services --- and what do we need to do to plan for that.

"COACT Colorado is a system of care for children and youth with behavioral health challenges and their families.

It uses an evidence-based and effective process called high-fidelity wraparound to manage care for families with complex needs who are involved in multiple systems.

"High-fidelity wraparound implements a collaborative plan for the child and the family, as well as service providers and professionals working with the family. The process utilizes the individual strengths, needs, and culture of the family to achieve desired goals.

"High-fidelity wraparound often makes case work easier and more efficient for providers and professionals while generating positive outcomes."

https://coactcolorado.org/for-providers

1. Family Voice and Choice
Family and youth perspectives and opinions are asked for often, and prioritized during all phases of the process. Planning is built on family members’ perspectives, and the team aims to build a plan that reflects a family’s values.

2. Team-based
The wraparound team consists of individuals providing services to the family as well as the family’s natural supports.

3. Natural supports
The team actively seeks out and encourages the full participation of team members drawn from family members’ own networks of interpersonal and community relationships.

The plan reflects activities and interventions that draw on these individuals as sources of natural support.

4. Collaboration
Team members work together and share responsibility for developing, implementing, monitoring and evaluating a single high-fidelity wraparound plan. The plan is a collaboration of all team members’ ideas, opinions and resources and guides each team member toward meeting the team’s goals.

5. Community-based
The team implements a plan that offers services and supports that take place in the most inclusive, responsive and accessible settings possible; and that safely promote child and family integration into home and community life.

6. Culturally competent
The process respects and builds on the values, preferences, beliefs, culture, and identity of the family, child, and their community.

7. Individualized
The team will develop and implement a customized set of strategies, supports, and services to achieve goals laid out in its plan.

8. Strengths-based
The high-fidelity wraparound process and plan identify, build on, and enhance the capabilities, knowledge, skills, and assets of the child and family, their community, and other team members.

9. Persistence
Challenges can and will come up throughout this process. However, the team will persist in working toward the goals laid out in the plan until the team reaches an agreement that the goals have been met and the formal process is no longer needed.

10. Outcome-based
The team ties the goals and strategies of the high-fidelity wraparound plan to measurable indicators of success and monitors progress by checking in on these indicators.

If something isn’t working, the team will revise the plan.

CO Medicaid's Challenge to "Uncover" & Meet the True Need for Assertive Community Treatment Under Parity -- NOW

3/12/2018

So what is the "Cover-Up" we're railing against now?
We're focused on the Insufficiency & Lack of Parity within Medicaid Mental Health Services generally and in Colorado specifically [although a lot of the criticisms could apply to other states as well].
First of all -- WE ALL WANT TO LOOK GOOD -- the State wants to look good, I want to look good, everybody I know wants to look good.
When people, or organizations, or governmental sub-divisions -- start not exactly telling the truth about something -- well, it's pretty easy to get into CROSS EXAMINATION MODE (especially in our society) -- to ferret out, uncover, reveal THE TRUTH.
IDEALLY, we make it safe enough that people can tell the TRUTH.
This becomes exceedingly problematic where safety is concerned.
AND Safety gets implicated A LOT where the Criminal Justice System is concerned -- whether its judges, prosecutors, defense attorneys, individuals, service providers, State actors responsible for ensuring adequate:

bed space
housing;
and services, often intensive services.

So Orchid Advocacy is pretty much focused on the State actors but of course they are inter-connected to all the other players, actors, individuals. What we want the State Actors to do in bringing:

Bed Space;
Housing
Services, often intensive services

TO SCALE or to have A COMPREHENSIVE, EFFECTIVELY WORKING PLAN TO BRING THE ABOVE TO SCALE to meet the needs of people with disabilities, often invisible disabilities, who are homeless, incarcerated or otherwise institutionalized is required by the LAW but it is also REALLY DIFFICULT -- that's why we're not doing it.
We do CRINGE when there is a significantly less than transparent and honest discussion and acknowledgement of the past and current difficulties to bring ACT to SCALE in Colorado.

Let's talk about Assertive Community Treatment in Colorado & Nationally:

Prior to "Federal Parity Legislation," the US Department of Justice relied on the Americans with Disabilities Act and the 1999 Olmstead Decision to FORCE States to provide more Assertive Community Treatment to people with disabilities who were institutionalized or at great risk of institutionalization.
In a New Hampshire Olmstead case, DOJ required the State of New Hampshire which is 1/3 the population of Colorado -- to provide significantly more Assertive Community Treatment as Colorado was providing at the time.
Colorado has historically considered ACT a "alternative service" under Medicaid in which there was no entitlement to the Service.
Further, a significant percentage of the ACT that Colorado does provide is not through Medicaid but through the Office of Behavioral Health. Well, why is that important -- Medicaid is an ENTITLEMENT [unless of course its an "alternative service in which case it's not an entitlement] so a lot of the rights that attach to most Medicaid Services have historically NOT attached to the provision of ACT in Colorado.
Additionally, the State of Colorado through the Dept. of Health Care Policy & Financing refused to respond to or answer a question we posed 2 & 1/2 years ago as to whether the state had an objection to a WAITLIST for ACT.
Currently, it appears --although we need to double-check-- that Colorado maybe now facially complying with Parity-- saying well, providers can seek reimbursement for ACT under the general "reasonable medical necessity" standard of Medicaid.
Why wouldn't that be enough? Well, the answer to that brings in not only:

*The Administrative & Economic Realities of ACT
*The HUGE historical resistance by Colorado State Gov't to provide full funding of this service--- we can't ignore HISTORICAL DISCRIMINATION.
*AND just the HUGE NEED to PLAN for what may be thousands of additional people with mental illness:
----who are in the Criminal Justice System
----nursing homes
----homeless
----in the Mental Health Institutes

Most States that have really been serious about this have included specific eligibility by Statute and/or regulation so that everyone is on the same page, and people who should be included aren't inadvertently left out due to vagueness.

Specifically such eligibility criteria often include along with a "mental Illness":

Criminal Justice Involvement
History of Hospitalization or Institutionalization; and
Homelessness

Colorado is moving in the right direction -- It needs to move much more to make ACT a SUBSTANTIVE REALITY FOR THE POTENTIALLY THOUSANDS OF ADDITIONAL PEOPLE WHO MAY MEET REASONABLE MEDICAL NECESSITY CRITERIA.

Examples of DOJ (US Department of Justice) Settlement Agreements that included ACT

DOJ Settlement Agreements that include ACT
U.S. v. New York – 13-cv-4165 – (E.D.N.Y. 2013)

Community-Based Mental Health Services

The Agreement will ensure that individuals with serious mental illness receive the array of services they need to successfully transition to, and remain in, community-based settings.

These services include ACT, mental health clinic services, personal care services, home health services, care coordination, and crisis services.

See Fact Sheet on the Agreement
http://www.ada.gov/olmstead/olmstead_cases_list2.htm#ny

U.S. v. North Carolina – No. 5:12-cv-557 – (E.D.N.C. 2012)
Following a nationally recognized fidelity model, the number of ACT teams throughout the State will expand to 50 ACT teams with the capacity to serve 5,000 individuals by July 1, 2019.

See Fact Sheet on the Agreement
http://www.ada.gov/olmstead/olmstead_cases_list2.htm#NC

Amanda D., et al. v. Hassan, et al.; United States v. New Hampshire, No. 1:12-CV-53 (SM)
-          Over the first three years of the Agreement, the State will expand ACT team service capacity so as to be able to serve at least 1,500 people in the target population {Of course, New Hampshire is only 1/3 the population of CO]; this expansion will provide ACT team services to hundreds of additional people in need.

-          The State will develop effective regional and statewide plans going forward to provide sufficient ACT services to ensure reasonable access by additional eligible individuals.

See Agreement Fact Sheet
http://www.ada.gov/olmstead/olmstead_cases_list2.htm#wood

The Hickenlooper Administration Mixed Bag is Alive & Well with Politeness & Unresponsiveness

2/20/2018

The level of both good government and bad government within the Hickenlooper Administration on first blush seems pretty extraordinary -- except when one realizes most Administrations are like that.
Generally, most people shrug those things off and to a great degree we do, too.
BUT some of it is really SCARY BAD GOVERNMENT and for the most part there is no real intent to do harm or for that matter even an appreciation that they are doing harm.
So why would you modify anything, if you don't even realize there is a problem?
So what is it that is so BAD:

Not responding to a question about starting a waitlist for a critical mental health treatment, specifically Assertive Community Treatment-- now working on 3 years since the question was first asked -- (CO Dept. of Health Care Policy & Financing--- -- I mean you) ;
Putting your own agenda above complying with Federal Law, specifically Olmstead (CO Department of Human Services -- I mean you)
Putting forth bad faith, non-legal grounds for the State's non-compliance with Olmstead -- Gov. Hickenlooper's Office --- I mean you.
Parity: The State's Response [paraphrasing] -- "we were really too BUSY to talk about this right now in DETAIL -- BUT we will take your concerns into account." The BUSYNESS DEFENSE to REAL INCLUSION & SUBSTANTIVE ENGAGEMENT is a real favorite of the Hickenlooper Administration and we've encountered it numerous times over the years.

All three of these Departments or Offices with the State are full of--- super bright, super talented. and super caring people--- BUT they are NOT above:

STONEWALLING,
VIOLATING THE LAW, or
Rationalizing all manner of non-inclusive, non-responsive bad government.

We need all the people in those State Departments and the the Departments that weren't specifically mentioned.

BUT we gotta have some REAL SUBSTANTIAL CHANGE in Colorado Medicaid & CDHS & the Gov.'s Office (of course, that's getting ready to change anyway but we don't want the STATUS QUO or heaven forbid something worse).
If such bright, talented, caring people can't do what needs to be done in mental health -- who can?
Well, we do know we want an Administration that:

WILL CONFRONT TABOR. Such confrontation of TABOR is needed in order to prevent the abuse, neglect and rights violations of Coloradans with disabilities, including rights to Housing & Sufficient Services;
OR An Administration that will put in the TIME & ENERGY for an EFFECTIVE WORK-AROUND to TABOR to prevent the abuse, neglect and rights violations of Coloradans with Disabilities, including rights to Housing & Sufficient Services.
Is committed to RADICAL INCLUSIVENESS for State Mental Health Policy-- what we want isn't really "radical" --- the inclusion of people with intensive mental needs in service planning & oversight -- BUT it would be "radical" for Colorado;
Is committed to COMPLYING with Federal CIvil Rights Laws; and
Does not engage in very polite but NON-RESPONSIVE, STONEWALLING tactics -- we don't want rude non-responsive, stonewalling tactics, either.

There are so many people in the Mental Health Community that want to work with the State--BUT we want a BIG BREAK with the STATUS QUO--like

REAL INCLUSION -- NOT just platitudes of "Thank you for your comments we'll take them into account";
Federal Civil Rights Law Compliance BOTH in Theory & Practice.
COURAGE -- to confront the State's Funding Difficulties and its HORRIFIC IMPACT ON COLORADANS WITH DISABILITIES.

TIME IS RUNNING OUT ON THE HICKENLOOPER ADMINISTRATION & MOST PEOPLE HAVE ALREADY MOVED ON TO THE GOVERNOR'S RACE.

BUT EVEN IF THAT IS WHERE YOUR FOCUS IS -- KNOWING WHAT YOU DON'T WANT IS AS IMPORTANT AS KNOWING WHAT YOU DO WANT.

The Hickenlooper Administration isn't all bad -- and in many respects they do GREAT things -- BUT we don't want the PAST SCARY BAD HABITS of COLORADO STATE GOV'T to be our PRESENT OR FUTURE REALITY.

"Dealing with Homeless, Fires and Lawsuits" -- A Modest Proposal

1/21/2018

With our Dark Humor, Colorado's situation of "Homeless, Fires, and Lawsuits," reminds us of the Plagues on ancient Egypt in the Bible.
Colorado's situation may not be as much Divine Intervention as the Chickens Coming Home To Roost -- of course, maybe it's the same thing.
In any case, we need NOT only to deal with the ROOT CAUSES of these problems --- BUT have the COURAGE & INTEGRITY to acknowledge the SCALE OF THE PROBLEMS.
On some level, Colorado is addressing the ROOT CAUSES of these problems -- BUT it hasn't really been wholly effective because STATE GOVERNMENT is afraid to acknowledge the SCALE of the Problems and their LEGAL RESPONSIBILITY to provide HOUSiNG & SERVICES for People with Disabilities or to Have a Plan to Bring Those Housing & Services to SCALE under the US Supreme Court's 1999 Olmstead Decision.
Why is that? Why are politicians afraid to do that?
I'm sure this is going to SHOCK everyone -- BUT the well recognized reason is that this isn't CHEAP -- in fact -- it's EXPENSIVE.
So when you have Governmental Entities not complying with various LAWS @ the State, County, or Municipal level --- LAWSUITS are pretty predictable.
Housing and Intensive Community Mental Health Treatment that many people who are Homeless need --- is EXPENSIVE.
There is not necessarily just one way to FUND that. One way that was pioneered by the City of Denver was the use of Social Impact Bonds.
We have said it before and we'll say it again -- one of the most SERIOUS & DANGEROUS problems Colorado State Government has is that it is woefully Under-Staffed.
As one professor said -- "You can't read 'War and Peace' while you're taking a shower."
You can't:

Make those applications for Social Impact Bonds;
Adequately Monitor Facilities
Sufficiently Engage with the Public on Innovative Ideas for a Pretty Broken Mental Health System
Etc.

If you don't have the Bandwidth to do it.

There is a HUGE NEED within the Colorado Dept. of Health Care Policy and Financing (HCPF) for MORE HUMAN RESOURCES to deal with the TRANSFORMATION that needs to take place in MEDICAID to ADDRESS the MENTAL HEALTH CRISIS that Colorado is experiencing and is seen in the rest of the Country as well.

Further, while we understand that the Office of Behavioral Health and HCPF are closely coordinating ---- we think these offices need to be fully integrated--- so that concerns relating to Institutional and Community Mental Health Care are seamlessly addressed.

Additionally, LET'S BE VERY CLEAR --- IT IS OFTEN CHEAPER FOR GOVERNMENTAL ENTITIES TO VIOLATE THE LAW AND PAY ATTORNEYS FEES FOR THE OCCASIONAL LAWSUIT THAN IT IS TO COMPLY WITH THE LAW THE WAY THE LAW IS CURRENTLY ENFORCED.

So if one's most important value is "saving taxpayer dollars" -- Colorado's got the Government for you.

BUT make no mistake about it, it comes with a lot of abuse and neglect of people with disabilities and inhumane treatment of people with mental illness on the streets and in jails and prisons.

If we work together, we can figure out a way to pay for Sufficient Housing & Services for People with Disabilities and make a Plan to bring those Housing and Services to SCALE.

Colorado Springs Gazette: Letter to the Editor

Dealing with homeless, fires, lawsuits

If you build it, more will come. We will never have enough space until the homeless get mental help to change their lifestyles.

I am referring to the hard core group (mainly singles) that refuse to obey any laws that don't suit their style of living.

I would also like to thank the ACLU for helping put fear in our community, especially legal residents of the Westside (Old Colorado City), by not allowing Colorado Springs to enforce it's laws for fear of being sued and wasting precious taxpayer dollars on legal fees.

Tom Gallivan
Colorado Springs

http://gazette.com/letters-dealing-with-the-homeless-fires-taxes-and-lawsuits/article/1619255

Colorado Abuse & Neglect Scandals Involving People with Disabilities

The Role of Counties & Municipalities In Insisting that States, like Colorado, Comply with the State's Obligations for Housing & Intensive Services for Citizens with Mental Illness

1/19/2018

The National "Stepping Up" Movement to get people with mental illness out of jails is sponsored in no small measure by the National Association of Counties.
Counties are often the ones funding the jails and the Sheriff's Offices.
So why would they do that? There are a lot of additional medical costs as well as heightened liability costs in trying to provide for people who really need a mental health facility or Intensive Community Mental Health Treatment and Housing.
This really should be a State Funding Responsibility and under the Americans with Disabilities Act and Olmstead -- IT IS.
So it is NOT like States aren't doing anything. They are. BUT they are NOT doing enough to comply with the LAW.
NOW if this was anybody else -- would partially complying with the LAW be enough?
Further, for the people with mental illness who find themselves caught in the Homeless/Incarceration Cycle --- that often is NOT enough, and it certainly wouldn't be enough in many cases if they had prior convictions that are really based on a Lifetime of mental illness and a State over decades failing to comply with the LAW.
SO We See the Injustice of This --- and its not like Coloradans aren't already paying for people with mental illness with intensive needs --- It is just that they are paying for it out of County and Municipal Coffers --- and more often than NOT what they are paying for is INHUMANE TREATMENT.
AND that is coming often from the Sheriff's and Deputies around the Country and in Colorado -- who have turned into some of the most eloquent Mental Health Advocates our Country and State have.
Colorado is already doing a lot of Collaborative work ---- it NEEDS to be much more inclusive of People with Mental Illness with experience with the Criminal Justice System -- and it is a very good start.
BUT State Government is still NOT complying with the Law. AND that can't be considered adequate or acceptable, especially given the damage and human toll that is resulting from the State's FAILURE to comply with the LAW.
Maybe a funding measure that would benefit the Counties and Municipalities for Housing for People with Disabilities as well as Funding to ensure that Intensive Community Mental Health as well as Institutional Mental Health Services were available where necessary.
We are going to make the argument that funding for Institutional Mental Health Services can be Olmstead Services when:

They are Directly Tied to Housing and Intensive Services in the Community, if necessary.
There is Strength-Based, Person-Centered Care Planning and Discharge Planning.
Discharge Planning Begins Upon Admission
The Mental Health Institutes assess and advise what services would be necessary in the Community for this Individual to Successfully Live in the Community.
If such services are NOT available. Consult with Colorado's Protection and Advocacy Office for People with Disabilities as well as the Colorado Department of Health Care Policy & Financing.

We do think it is important to get to a more HOLISTIC & COMPREHENSIVE approach to the provision of Mental Health Services and Housing both at the State and Federal Levels.

-----Johnny Cash

Val's Blog